bio4360_sept. 19th, 2011

Algonquin College © Dr. Jim Panchuk 2011 Oral Medicine BIO4360

BIO4360 Oral Medicine

Etiology of Pathologies IIMonday, Sept. 19th, 2011


MetabolicInflammatoryNeoplasms

Developmental

Metabolica) Hormonalb) Nutritionalc) Compromised Organ Systems

Inflammatorya) Traumab) Infection – viral, fungal, bacterialc)Immunologic - autoimmune

‘MIND’ Algorithm


Inflammatory – c) immunologic

i) immune response to body’s own antigens (autoimmune) -pemphigus, pemphigoid

ii) allergic reaction to external antigen - cinnamon, toothpaste, medications, etc.



Inflammatory – c) immunologic

i) immune response to body’s own antigens (autoimmune) -pemphigus, pemphigoid

ii) allergic reaction to external antigen - cinnamon, toothpaste, medications, etc.

Inflammatory – d) reactive

-body’s response to chronic, physical irritation -papillary hyperplasia, pyogenic granuloma, epulis

fissuratum



‘MIND’ AlgorithmNeoplasms – benign, premalignant, malignant

-usually some change in surface colour &/or texture- +or- swelling &/or pain-usually one location and enlarges from that point-risk factors (tobacco &/or alcohol)


‘MIND’ AlgorithmNeoplasms – benign, premalignant, malignant

-usually some change in surface colour &/or texture- +or- swelling &/or pain-usually one location and enlarges from that point-risk factors (tobacco &/or alcohol)

Developmental

-genetic – Basal Cell Nevus (mole), Macule

-acquired – cleft palate

-other – geog. tongue, leukodema


12 Questions to Ask““Listen to your patient and the patient Listen to your patient and the patient

will give you the diagnosis” will give you the diagnosis” Sir William OslerSir William Osler


12 Questions to Ask1) How long has the problem been present?

-if <2-3 weeks more likely inflammatory etiology-less likely developmental, neoplasm, metabolic

-if > 5-6 wks poss. of neoplasm

2) Has it happened previously, and, if so, did it go away completely?

-if occurred before and healed completely chance of neoplasm is minimal

-inflammatory more likely -infectious (herpes, recurrent fungal infection)-immunologic (apthous ulcer, lichen planus)


12 Questions to Ask3) Is it happening (has it occurred) in other locations in your mouth

-multiple locations almost always rule out neoplasms- likelihood of trauma-location also important ex: attached vs. unattached


12 Questions to Ask3) Is it happening (has it occurred) in other locations in your mouth

-multiple locations almost always rule out neoplasms- likelihood of trauma-location also important ex: attached vs. unattached

4) Does it hurt? And if it does, chose one word to describe the pain.

-one of 4 aspects of inflammation-‘burning’ more chance of fungal etiology***important to let patient chose word***


12 Questions to Ask5) Has it grown/become worse/spread to other spots?

+ve response (along with location) will affect prob. of metabolic etiolology

-or neoplasm, esp. malignancy which will grow in size but seldom spread

RememberRemember….all questions build on each other

Must link info gained from various questions

Ex: pain for 4 weeks, several locations, pain is more ‘burning, seems to be spreading slightly…..

Likelihood of fungal infection is fairly high


12 Questions to Ask6) What can you do/have you done that makes it better or worse?

-if stopped using product and it resolved…immunologic -hypersensitivity/allergic rxn-improves with salt water, worsens with orange juice -ulceration/erosion


12 Questions to Ask6) What can you do/have you done that makes it better or worse?

-if stopped using product and it resolved…immunologic -hypersensitivity/allergic rxn-improves with salt water, worsens with orange juice -ulceration/erosion

7) Does it come and go/change during the day?

-if rapid change…….trauma related-if stress related…..less in morning, worse later in day-around mealtime?


12 Questions to Ask

8) Do you remember injuring the area of the lesion?

-identify trauma or recurrent trauma


12 Questions to Ask



9) Do you have any lesions on other parts of your body?

-increased potential for immunologic cause-auto-immune diseases with dermatologic symptoms-some developmental lesions also have skin changes

(café au lait spots)


12 Questions to Ask



9) Do you have any lesions on other parts of your body?

-increased potential for immunologic cause-auto-immune diseases with dermatologic symptoms-some developmental lesions also have skin changes


12 Questions to Ask10) Do other people in your family have anything similar?

-family Hx points to developmental problem (usually)




11) How is your general health? Other than the oral problem, do you feel medically well?

-if ‘yes’ less likely due to metabolic or systemic disease




11) How is your general health? Other than the oral problem, do you feel medically well?

-if ‘yes’ less likely due to metabolic or systemic disease

12) Are you taking any medication for any reason currently or were you taking medication recently?

-verifies info about general health-oral effects of meds


12 Questions to AskREMEMBER:

-intra-oral exam is NOT all that’s required to arrive at diagnosis

-need to combine with info gained from questioning

-either confirm Dx or lead to next step in tmt plan

-biopsy, drug therapy, or ‘watchful waiting’ depends on suspected etiology


12 Questions to Ask

-some conditions have multiple etiologies Ex: AIDS, Leukemia are Metabolic (compromised organ

system-but oral problems typically of the Inflammation category (infection)

-MIND does not include conditions secondary to psychologic problems

-anxiety, phobias, self-inflicted trauma


Available Online


BIO4360 Oral Medicine

Monday, Sept. 19th, 2011

Herbal Products and Supplements


Come One, Come all


The products and the claims made about specific products on or through this site have not been evaluated by Herbal Remedies or the United States Food and Drug Administration and are not

approved to diagnose, treat, cure or prevent disease. The information provided on this site is for informational purposes only and is not intended as a substitute for advice from your

physician or other health care professional or any information contained on or in any product label or packaging. You should not use the information on this site for diagnosis or treatment of any health problem or for prescription of any medication or other

treatment. You should consult with a health care professional before starting any diet, exercise or supplementation program,

before taking any medication, or if you have or suspect you might have a health problem.

Disclaimer


Beliefs-Canadian studies have shown herbal medicines being used by 30-35% of people

“Patients often believe that herbs are natural alternatives to prescription medications, and do not recognize that herbs are composed of bio-active chemicals which may be toxic and can interact with other medications”

Arch Fam Med 1998;7(6):523-36

"Better Living Through Chemistry"


Beliefs-Canadian studies have shown herbal medicines being used by 30-35% of people

“Patients often believe that herbs are natural alternatives to prescription medications, and do not recognize that herbs are composed of bio-active chemicals which may be toxic and can interact with other medications”

Arch Fam Med 1998;7(6):523-36

"The miracles of science"


EthnobotanyBotany + Anthropology


Ethnobotany

Phillippus Aureolus Paracelsus1493-1541AD

“It’s the dose that makes the poison”

Botany + Anthropology


Ethnobotany

Poisonous plants are medicinal plants

&

Medicinal plants are poisonous plants

Herbal medications are important


Herbal based Medicines-1900’s – herbal supplements hallmarks of pharmaceutical

industry

-67% of all medicine listed in US Pharmacopeia were

botanicals……now only 2%

- >1/2 of “modern” prescription & OTC drugs have botanical

origins (aspirin, caffeine, cyclosporine, digoxin, quinine)


Herbal based Medicines-1900’s – herbal supplements hallmarks of pharmaceutical

industry

-67% of all medicine listed in US Pharmacopeia were

botanicals……now only 2%

- >1/2 of “modern” prescription & OTC drugs have botanical

origins (aspirin, caffeine, cyclosporine, digoxin, quinine)

-ethnobotany very important

- < 0.5% of the world’s vanishing tropical plant species have been investigated for their medicinal qualities


Herbal Medicine~7000 plants have medicinal applications

-75% of world’s pop’n rely on plants for health care

-in NA most use for prevention and health maintenance

-pharmaceuticals target symptomatic/curative medicine

-majority of knowledge on plant derived medicine is traditional

-Herbals reputation hampered by:

-lack of standardization

-lack of clinically verifiable safety and efficacy


Definitions

Dietary Supplement (DSHEA):

a product (other than tobacco) that:

-Is intended to supplement the diet

-Contains one or more dietary ingredients or their

constituents

-Is intended to be taken by mouth

-Is labeled as being a dietary supplement.


Definitions

Herbal supplements:

-are one type of dietary supplement

-An herb is a plant or plant part (leaves, flowers, seeds,

roots) that is used for its flavor, scent, and/or

therapeutic properties

-"Botanical" is often used as a synonym for "herb."

-may contain a single herb or mixtures of herbs.


Regulations (USA)-US Dietary Supplement Health and Education Act (1994)

-compromise

-exempts vitamins, minerals, & botanical products from

meaningful FDA regulation


Regulations (USA)-US Dietary Supplement Health and Education Act (1994)

-compromise

-exempts vitamins, minerals, & botanical products from

meaningful FDA regulation

-burden of proof?

-2006 – Changes to Federal food, Drug and Cosmetic Act

-require industry to report all serious dietary supplement

related adverse drug effects to the FDA

-2007-10 – manufacturers must test for purity,

-ensure no contaminants

-verify contents match labeling information


-Labeling according to the DSHEA:

-prevents use of therapeutic claim

ex: “for treatment of hypertension”

-must be labeled as dietary supplement

-CAN contain claims of effect on structure or function of

body (ex: increases immunity)

Regulations (USA)







body (ex: increases immunity) -info does not have to be scientific, but cannot be false or misleading (responsibility in hands of FDA)

Multiple violations / near violations

Regulations (USA)


… your webpage …. bears the following claim: "[F]our recent studies in people at risk for coronary disease have shown a significant cholesterol lowering effect from tea or tea flavonoids ... One of these studies, on post-menopausal women, found that total cholesterol was lowered by 8% after drinking 8 cups of green tea daily for 12 weeks ....“

The therapeutic claims on your website establish that the product is a drug because it is intended for use in the cure, mitigation, treatment, or prevention of disease.

Regulations (USA)


Your Sparkling Green Tea Ginger Ale bears the claim, "ENHANCED WITH 200 mg OF ANTIOXIDANTS FROM GREEN TEA & VITAMIN C**" with the double asterisk referring to the statement, "* *Each 8 oz serving contains 200 mg of antioxidants from Green Tea Flavonoids and Vitamin C" on the principal display panel of the product label. In the context of this label the term "enhanced" is an unauthorized synonym for a "more" nutrient content claim. FDA has defined the nutrient content claim "more" and its authorized synonyms in 21 CFR 101.54(e).

Regulations (USA)







body (ex: increases immunity) -info does not have to be scientific, but cannot be false or misleading (responsibility in hands of FDA) -information can be physically separate from the product

(ie: product on one shelf, info in another isle) HUH?????

Regulations (USA)


Canada: Natural Health Product Regulations (2004)

-allowed for sale of products otherwise not allowed under

the Food and Drug Regulations

-pre-2004 natural health products either drugs, or foods

(Food and Drug Act)

Regulations (Canada)



-allowed for sale of products otherwise not allowed under

the Food and Drug Regulations

-pre-2004 natural health products either drugs, or foods

(Food and Drug Act)

-different sets of reg’s for cosmetics, foods, drugs, etc.

-burden of proof varies




Natural health products (NHPs) are defined as:

-vitamins and minerals,

-herbal remedies (ex: St. John’s Wort),

-homeopathic medicines **

-traditional medicines (Traditional Chinese Medicines),

-probiotics,




Natural health products (NHPs) are defined as:

-vitamins and minerals,

-herbal remedies (ex: St. John’s Wort),

-homeopathic medicines **

-traditional medicines (Traditional Chinese Medicines),

-probiotics,

-other products like amino acids and essential

fatty acids.



Canadian Database


Labeling Requirements (Can)Brand NameProduct/Herb NameStructure/Function ClaimsDisclaimerNumber of Product and Net Weight of EachDirections for useSupplement FactsManufacturer’s or distributor’s name, city, state, zip

codeExpiration date


Energy Drinks-call for Health Canada to get involved with regulating

-if considered ‘foods’ only have to list ingredients

-talks about natural product not having to label caffeine

containing herbal ingredients

-if ‘natural health products’ also have to have appropriate

warnings

packs 505 mg of caffeine and 5000 mg of taurine

Beverage…..or drug delivery systems??


Energy Drinks


Alcoholic Energy Drinks

bio4360_sept. 19th, 2011

Health & Medicine

jim panchuk

alcoholalgonquin college

leukodemaalgonquin college

unattachedalgonquin

lichen planusalgonquin

mouthmultiple locations

ve response

important ex